Benefit of bed rest in threatened miscarriage

There is simply no evidence of any positive benefit of bed-rest in threatened miscarriage. The standard advice is to try to avoid physical and mental stress. This may actually be achieved by trying to carry on as normally as possible. There is no evidence at all that bed rest actually improves chances of avoiding a miscarriage.

It may be important to focus on the positive, which is that the possibility of a successful resolution is, on balance, really quite high.

Diagnosing fetal demise

Sometimes the fetus dies at an early stage of the pregnancy but actual miscarriage does not take place. This is termed missed abortion or missed miscarriage.

The warning of a missed miscarriage may come in the form of disappearance of the pregnancy symptoms and/or a light blood-stained or dark-brown vaginal discharge. Sometimes there is light vaginal bleeding which tends to be painless.

An ultrasound will confirm presence of a pregnancy in the womb and absence of fetal heartbeat.

Managing fetal demise (missed miscarriage)

There are options. If there is some doubt to the diagnosis, advice is given to do nothing and have a repeat scan in about a week or two. This will remove any doubts one way or the other.

If the diagnosis is not in doubt, the mother may opt for expectant management, where she waits for spontaneous miscarriage to take place. Medical management involves taking medication to expedite the process of miscarriage.

The final alternative is surgical. Here, the contents of the uterus are evacuated surgically, normally under a general anesthetic. This is a minor procedure which takes about fifteen minutes to perform. The woman is usually fit to go home two or three hours later.

Complete or incomplete miscarriage

Sometimes a scan will show that the miscarriage has already taken place. In such a case, the question the doctor has to answer is whether the miscarriage is complete or whether there are still some products of conception retained in the uterine cavity, the latter known as incomplete miscarriage (abortion).

If miscarriage is complete, then nothing further needs be done. If it is incomplete, then the woman may be given the options of either allowing the miscarriage to complete naturally (provided that the bleeding has settled and appears insignificant), take medication to expedite completion or go to theatre to evacuate the remnants.

Other measures in case of a miscarriage

If the woman's blood group is Rhesus negative, she needs an injection of anti-D. This is administered to all Rhesus negative women who bleed in pregnancy regardless of whether the pregnancy is still viable or not.

The anti-D is meant to protect the woman from developing antibodies in her blood. The antibodies, if they were to develop, could have an adverse effect on future pregnancies.

If miscarriage was very early (before 10 weeks); the injection may not be necessary. More often doctors err on the side of caution and recommend the injection regardless of gestation.

Anti-D can only be administered as an injection. There is no oral option. Rhesus positive women do not require this injection.